Provider Demographics
NPI:1780890731
Name:COOK, VIRGINIA VALERIE (PHD, CPNP)
Entity type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:VALERIE
Last Name:COOK
Suffix:
Gender:F
Credentials:PHD, CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10608 E MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:SUN LAKES
Mailing Address - State:AZ
Mailing Address - Zip Code:85248-8806
Mailing Address - Country:US
Mailing Address - Phone:480-895-7322
Mailing Address - Fax:
Practice Address - Street 1:10608 E MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:SUN LAKES
Practice Address - State:AZ
Practice Address - Zip Code:85248-8806
Practice Address - Country:US
Practice Address - Phone:480-895-7322
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN059920363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics